Correction: Clinical response to discontinuation of anti-TNF therapy in patients with ankylosing spondylitis after 3 years of continuous treatment with infliximab

Rheumazentrum Ruhrgebiet, Herne, Germany.
Arthritis research & therapy (Impact Factor: 4.12). 03/2005; 7(3):R439-44. DOI: 10.1186/ar1693
Source: PubMed Central

ABSTRACT We analyzed the clinical response and the time to relapse after discontinuation of continuous long-term infliximab therapy in patients with ankylosing spondylitis (AS). After 3 years of infliximab therapy, all AS patients (n = 42) discontinued treatment (time point (TP)1) and were visited regularly for 1 year in order to assess the time to relapse (TP2). Relapse was defined as an increase to a value >or= 4 on the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) and a physician's global assessment >or= 4 according to the recommendations of the Assessments in Ankylosing Spondylitis (ASAS) working group. After 52 weeks, 41 of the 42 patients (97.6%) had to be reinfused because of relapse. The mean change in the BASDAI between TP1 and TP2 was 3.6 +/- 1.7 and that in the physician's global assessment was 4.4 +/- 1.8 (both P < 0.001). The mean time to relapse was 17.5 weeks (+/- 7.9 weeks, range 7 to 45). Ten patients (24%) showed a relapse within 12 weeks and 38 patients (90.5%), within 36 weeks. After 52 weeks, only one patient had remained in ongoing remission without further treatment with anti-tumor-necrosis factor. Patients who were in partial remission according to the ASAS criteria and those with normal C-reactive protein levels at the time point of withdrawal had longer times to relapse after discontinuation of the treatment. Retreatment with infliximab was safe and resulted in clinical improvement in all patients to a state similar to that before the treatment was stopped. Discontinuation of long-term therapy with infliximab eventually led to relapse of disease activity in all patients but one.

Download full-text


Available from: Herbert Kellner, Jun 30, 2015
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Remission is a major goal of medical therapy in chronic disease. Ankylosing spondylitis (AS) is a chronic inflammatory rheumatic disease that affects the axial skeleton and other body structures, causing pain, stiffness, functional loss, and disability. Until recently only symptomatic therapies were available, and control was poor in patients with severe disease. However, the TNF antagonists have now changed this substantially. The concept of disease remission in AS has not received much attention in the current literature. There exists one set of partial remission criteria formally developed by the ASsessments in Ankylosing Spondylitis (ASAS) working group on the basis of clinical trials with nonsteroidal anti-inflammatory drugs for use in clinical trials. Furthermore, a state of low disease activity has been defined empirically in studies of anti-tumour necrosis factor (anti-TNF) therapy to describe clinically relevant treatment efficacy. As more effective therapies become available for AS, disease remission is increasingly regarded as an appropriate therapeutic goal that may then be translated into modification of progressive structural damage. There is a need to further define and evaluate current proposals concerning remission in AS.
    Clinical and experimental rheumatology 24(6 Suppl 43):S-88-92. · 2.97 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: There are clear differences in the clinical picture and in the pathogenesis between rheumatoid arthritis (RA) and ankylosing spondylitis (AS). Biologic agents targeting TNF-alpha are efficacious in both diseases, with some tendency to work even better in spondyloarthritides (SpA) on a clinical basis. However, anti-TNF therapy was shown to inhibit radiographic progression in RA but not in AS. This is probably due to the outstanding difference in pathogenesis: while in RA osteodestructive lesions such as erosions predominate, AS patients will rather develop osteoproliferative changes such as syndesmophytes. There is some evidence that anti-TNF agents may show longterm efficacy and acceptable safety profiles over 5-10 years. There are some differences between the agents.Whether the recent developments of targeted therapies in RA with agents such as rituximab, abatacept and tocilizumab will also work for AS is unknown at present.
    Clinical and experimental rheumatology 27(4 Suppl 55):S164-7. · 2.97 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: In this paper we propose an adaptive nonlinear image representation based on the divisive normalization of local-frequency transforms used in contrast masking models. This normalized representation has two effects: (1) it increases the statistical independence of the coefficients of the representation and (2) it is Euclidean from a perceptual point of view. Experimental results show that reducing the remaining statistical and perceptual dependence using normalized representations for transform coding may make a big difference in the qualify of the reconstructed images.
    Signals, Systems and Computers, 2003. Conference Record of the Thirty-Seventh Asilomar Conference on; 12/2003